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AM- STEP1 > Last Set 2 > Flashcards

Last Set 2 Flashcards

1
Q

In what gestational week does they thyroid begin to develop?

Embryonic origin?

A

Third week of gestation

Derived from endoderm from the floor of the primitive pharynx

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2
Q

Hypothyroidism will cause elevation in what labs?

A

LDL and Total cholesterol

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3
Q

Attributable risk?

A

(A/ A+B) - (C/ C+D)

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4
Q

Orphan annie eyes

A

Papillary thyroid cancer

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5
Q

Mutation of papillary thyroid cancer

A

RET gene mutation

BRAF

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6
Q

Uniform cuboidal cells lining follicles and invading capsule

  • spread
  • associated with
A

Follicular thyroid carcinoma

Hematogenously
RAS mutation
PAX8-PPAR gamma 1 rearrangment

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7
Q

Tumor of thyroid
Increased level of calcitonin

Associated with
Mutation

A

Medullay thyroid carcinoma

Proliferation of parafollicular C cells

RET gene mutation
MEN 2A and MEN2B

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8
Q

What type of cancer in thyroid?

1) Arises from parafollicular C cells
2) RAS mutation or a PAX8-PPARy-1 rearrangment
3) Rearrangement in RET oncogene
4) Mutation in BRAF gene
5) Enlarged thyroid cells with ground-glass nuclei

A

1) Medullary thyroid carcinoma
2) Follicular thyroid carcinoma
3) Medullary thyroid carcinoma, papillary carcinoma
4) Papillary carcinoma
5) Papillary thyroid cancer

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9
Q

Lipodystrophy

Caused by

A

Distortions in the structure or function of adipose tissue

Buffalo hump

Leptin deficiency
HIV medication
- Protease inhibitors

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10
Q

Deficient in factor IX

A

Hemophilia B

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11
Q

Deficient in Factor VIII

A

hemophilia A

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12
Q

RL step of coagulation pathway

A

Factor X

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13
Q

Warfarin inhibits

A 
Factor II (thrombin)
Factor VII (extrinsic)
Factor IX (intrinsic) 
Factor X
Protein C 
Protein S
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14
Q

What is essential for coagulation cascade

A

Calcium

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15
Q

Factor XI

A

Kallikrein

Activates plasminogen –> plasmin (breaks down fibrin mesh)

Produces Bradykinin

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16
Q

Prothrombin time (PT)

A

Add tissue factor and see how long for clot to form

Test

  • Tissue factor pathway
  • Final common pathway

Factor VII
Factor X
Factor V
Factor II (prothrombin)

Resported with INR

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17
Q

Partial thromboplastin time (PTT)

A

25-40 seconds

Taking plasma add material to activate contact activation pathway

Factor XII
Factor XI
Factor IX
Factor VIII
Factor X
Factor V
Factor II (prothrombin)
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18
Q

Hemophilia A and B

  • deficiency
  • increases
A

Hemophilia A
- Factor VIII deficiency

Hemophila B
- Factor IX deficiency

Increase PTT

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19
Q

Coagulation disorders vs platelet disorders cause what type of bleeding

A

Coagulation disorders
- macrohemorrhages

Platelet disorders
- Microhemorrhages

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20
Q

Vit K deficiency

A

Cofactor for several clotting factors

Factor II, VII, IX, X, C and S

diSCo started in 1972

Increase PT and PTT

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21
Q

Antithrombin deficiency

  • resistant to
A

Hypercoagulable

Unable to inactivate thrombin

Resistant to heparin

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22
Q

Protein C deficiency

A

Hypercoagulable

Unable to inactivate factor V and VIII

or deficiency in protein S

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23
Q

Which glomerular disease should be suspected most in patients with each of the following findings?

  1. IF: granular pattern of immune complex deposition; LM; diffuse capillary thickening
  2. IF: granular pattern of immune complex deposition; LM: hypercellular
  3. IF: linear pattern of immune complex deposition
  4. EM: subendothelial humps and “tram track” appearance
  5. Nephritis, deafness, cataracts
  6. LM: crescent formation in the glomeruli
  7. LM: segmetnal sclerosis and hyalinosis
  8. EM spiking on the GBM due to electron-dense subepthelial deposits
A
  1. Membranous GN
    Diffuse proliferative GN
  2. Acute post-streptococcal GN
  3. Goodpasture syndrome
  4. Membranoproliferative GN
  5. Alport syndrome
  6. Rapidly progressive GN
  7. Focal segmental glomerulosclerossi
  8. Membranous GN
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24
Q

RBC with uniform spikes all over surface

A

Burr cell
Echinocyte

Uremia
Renal failure
Pyruvate kinase deficiency

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25
Q

RBC with irregular spikes in size and distribution

A

Spur cell
Acanthocyte

Abetalipoproteinemia

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26
Q

RBCs looks like bulls eye

A

Target cells

“HALT” said the hunter to his target

Hemoglobin C disease
Asplenia
Liver disease
Thalassemia

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27
Q

Tear drop RBCs

A

Myelofibrosis

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28
Q

An 18-year-old woman presents to the emergency department with acute onset of severe abdominal pain. She says she had a similar attack 1 year earlier after taking some barbiturates.
At that time she underwent an exploratory laparotomy, which revealed nothing. The
patient no longer takes barbiturates but recently
started an extremely low-carbohydrate and low-calorie diet. She has a temperature of
37°C (98.6°F), a respiratory rate of 16/min, and a blood pressure of 128/83 mm Hg. Her
WBC count is normal. Laboratory studies reveal a sodium level of 127 mEq/L, and urinalysis
shows increased porphobilinogen levels.
The physician tells the patient that she has a genetic condition involving her RBCs. What
congenital disorder did the physician most likely tell the patient she has?
(A) Acute intermittent porphyria
(B) Fanconi’s anemia
(C) Hereditary spherocytosis
(D) Porphyria cutanea tarda
(E) Sickle cell disease

A

A. Acute intermittent porphyria

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29
Q

Deficiency in Acute intermittent porphyria

Excess

A

deficit in uroporphyrinogen 1 synthetase (porphobilinogen deaminase)

Excess δ-aminolevulinate and porphobilinogen in the urine.

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30
Q

Dark red urine
Psychologic disturbances
Polyneuropathy
Abdominal pain

  • deficiency
  • drug that precipitated

Treatment

A

Acute intermittent porphyria

Uroporphyrinogen-1 synthase
(porphobilinogen deaminase)

Precipitated by

  • Barbiturates
  • Seizure durgs
  • rifampin
  • metoclopramide

Give Heme and Glucose
- down regulates delta-ALA synthase

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31
Q

Sun sensitivity –> blistering
Tea colored urine
Excess hair growth
Hyperpigmentation

  • associated with
  • increased lab
  • deficiency
A

Porphyria cutanea tarda

Associated with hepatitis C and alcoholism

Increase LFTs

Uroporphyrinogen decarboxylase

AD

Build up uroporphyrinogen III

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32
Q 
Abdominal pain
Renal failure
Mental deterioration
Foot/ wrist drop
Memory loss

Tx

A

Lead poisoning

EDTA
Succinmer
Severe poisoning in child
- Dimercaprol + succimer

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33
Q

RL step of Heme synthesis

A

delta-ALA synthase

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34
Q

Chipmunk face
Hair on end appearance on xray of skull
Target cells

A

Beta thalassemia Major

Increase Hemoglobin F
2 alpha, 2 gamma

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35
Q

What is the RL step of beta oxidation of fatty acids

A

Carnitine acyltransferase I

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36
Q 
Hypersegmented neutrophila
Anemia
Glossitis
Neurologic deficits
Increased homocysteine
INcreased MMA
A

B12 deficiency

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37
Q

Hypersegmented neutrophils
Glossitis
Increased homocysteine
Normal methylmalonic acid

A

Folate deficiency

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38
Q

Anemia
Increased CMV
Hypersegmented neutrophils Orotic acid in urine

-deficiency

A

Orotic aciduria

Deficiency of UMP synthase

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39
Q

ADAMTS13

A

TTP

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40
Q
  1. Low-molecular-weight heparins (LMWH) are
    distinct from unfractionated heparin in several
    ways. Which of the following is the primary
    target of LMWH?
    (A) Antithrombin III
    (B) Factor IIa
    (C) Factor VII
    (D) Factor Xa
    (E) Factors II, IX, and X
A

(D) Factor Xa

LMWH act on Xa

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41
Q

Eczema
Recurrent infections
Thrombocytopenia

A

Wiskott-aldrich syndrome

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42
Q

Von Willebrand disease

tx

A

DDAVP
- desmopressin (ADH analog)

ADH increase release of vWF from storage sites in endothelial cells

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43
Q

t (8;14)

A

Burkitt lymphoma

c-MYC

Starry sky appearance

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44
Q

t(14;18)

A

Diffuse large B cell lymphoma
-Elderly

Follicular lymphoma

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45
Q

t(11;14)

A

Mantle cell lymphoma

Disruption of regulation of cyclin D

46
Q

t(15;17)

tx

A

M3 AML

Treat w/ all-trans retinoic acid

47
Q

Rouleaux formation

A

RBC stacked like coins

MM

48
Q

Myeloproliferative neoplasma

3 types

mutation

A

Monclonal proliferation of mature myeloid cells

Types

  • polycythemia vera
  • essential thrombocytosis
  • myelofibrosis

Mutation
- JAK2

49
Q

Liver metastasis

A

“Cancer Sometime Penetrates Benign Liver”

Colon
Stomach
Pancreas
Breast
Lung

Colon&raquo_space; stomach > pancreas

Elevated LFTs
Abdominal pain
Hepatomegaly
Ascites
Jaundice
50
Q

Brain Metastasis

A

“Lots of Bad Stuff Kills Glia”

Lung
Breast
Skin (melanoma)
Kidney
GI tract

Lung > breast > melanoma, colon, kidney

HA
Neurological deficits
Cognitive function
Seizures

Well circumscribed tumors at grey/white matter junctions

51
Q

Bone Metastasis

A

“Permanently Relocated Tumors That Like Bone”

Prostate
Renal cell cancer
Testes
Thyroid
Lung 
Breast

Prostate, breast > lung, thyroid, kidney

52
Q

Mutation in APC

  • type mutation
  • seen in
A

Tumor suppressor genes

Negative regulator of beta-catenin/WNT pathway

Familial adenomatous polyposis

Colon cancer

53
Q

NF1 mutation

  • type of mutation
  • chromosome
  • presentation
A

Tumor suppressor protein
- Neurofibromin (Ras GTPase activating protein)

NF type 1

Neurofibromas, cafe au lait spots

Chr 17

54
Q

NF2 mutation

  • type of mutation
  • chromosome
  • presentation
A

Tumor suppressor protein
- Merlin (schwannomin) protein

NF type 2

Bilateral acoustic schwannoma

chr 22

55
Q

K-RAS mutation

H-Ras mutation

N-RAS mutation

  • type
  • seen in
A

oncogene mutation

Colon
Lung
Pancreatic tumors

Bladder and kidney tumors

Melanomas
Hematologic malignancies
Follicular thyroid cancer

56
Q

RET mutation

  • type mutation
  • associated with
A

oncogene mutation
- receptor tyrosine kinase

MEN 2A and 2B

  • Pheochromocytoma
  • Medullary thyroid cancer

Papillary carcinoma of thyroid

57
Q

c-myc

  • type mutation
  • seen in
A

oncogene mutation
- transcription factor

burkitt lymphoma

58
Q

What is the RL enzyme in purine synthesis?

RL enzyme in pyrimidine synthesis?

A

Purine: Glutamine PRPP amidotransferase

Pyrimidine: Carbamoyl phosphate synthase 2

59
Q

Tartrate-resistant acid phosphatase (TRAP)

A

Hairy cell leukemia

60
Q

RL enzymes for each?

  1. Urea cycle
  2. Hexose monophosphate pathway
  3. Fatty acid synthesis
  4. Beta-oxidation of fatty acids
  5. Ketone body synthesis
  6. Cholesterol synthesis
  7. Bile acid synthesis
  8. Heme synthesis
A
  1. Carbamoyl phosphate synthetase I
  2. Glucose 6 phosphate dehydrogenase
  3. Acetyl CoA carboxylase
  4. Carnitine acyltransferase
  5. HMG CoA synthase
  6. HMG CoA reductase
  7. 7-alpha hydroxylase
  8. Aminolevulinate synthase
61
Q

What are the irreversible enzymes involved in gluconeogenesis?

A

Pyruvate carboxylase (pyruvate –> oxaloacetate)

PEP carboxykinase
(oxaloacetate –> phosphoenolpyruvate)

Fructose 1,6 bisphosphatase
(Fructose 1,6- bisphosphate –> Fructose 6 phosphate)

Glucose 6 phosphate
(Glucose 6 phosphate –> glucose)

62
Q

Transfusion reactions

A

Type II hypersensitivity

63
Q

Lupus

  • type of rxn
  • deficiency of
A

type II hypersensitivity

C1q, C4, C2

64
Q

Fluoxetine affects neurons arising from

A

SSRI

From Raphe nucleus

65
Q

NE is from

A

Locus cereuleus

66
Q

GABA from

A

Nucleus accumbens

67
Q

Dopamine from

A

Ventral tegmentum SNc

68
Q

Leukomoid vs CML

A

Leukomoid
- high alkaline phosphate (LAP)

CML
- low leukocyte alkaline phospahtase

69
Q 
Fever
Diarrhea
Splenomegaly
Muscle wasting
Pancytopenia
A

Bitten sand fly

Leishmania spp

70
Q

Leukotrienes do what

A

LTC4
LTD4
LTE4

Increase bronchial tone

LBT4
- increase neutrophil chemotaxis

71
Q

Prostacyclin do what

A

Decrease platelet aggregation

Decrease vascular tone

72
Q

Prostaglandins do what

A

Decrease vascular tone

Increase uterine tone

73
Q

Thromboxane do what

A

Increase platelet aggregation

Increased vascular tone

74
Q

Pulmonary embolism does what to pH, PaO2, PaCO2, Serum HCO3

A

pH increase
PaO2 decrease
PaCO2 decrease
Serum HCO3 Normal

PE occludes parenchyma resulting in increased dead space ventilation

Hyperventilation –> hypocapnia and respiratory alkalosis

Acute so no bicarb involvement yet

75
Q

Bacteria virulence factor simlar to tropomyosin and myosin.

Fxn

A

M protein

Resist phagocytosis

Group A streptococcus

  • S pyogenes
  • cross rxn causes rheumatic carditis
76
Q

Decreased pulmonary capillary wedge pressure

A

Right sided heart failure

Impaired blood flow from right ventricle to left side of heart

77
Q

Antibodies to phospholipase A2 (PLA2R)

A

Membranous nephropathy

78
Q

Magnesium salts and aluminum hydroxide together for antiacid

A

Magnesium causes diarrhea

Aluminum hydroxide causes constipation

Both temporarily increase the gastric pH by neutralizing hydrochloric acid relieving reflux

79
Q

Common source of hemorrhage from penetrating gastric ulcers

A

Right and left gastric arteries that run along lesser curvature of stomach

80
Q

Saddle nose and oliguria

CXR?

A

Granulomatosis with polyangiitis (Wegeners)

Large nodular densities

81
Q

Which testicular tumor is associated with each?

1) Composed of cytotrophoblasts and syncytiotrophoblasts?
2) May present initially with gynecomastia
3) Elevated AFP
4) Elevated beta-hCG
5) Histologic appearance similar to koilocytes (cytoplasmic clearing)

A
  1. Choriocarcinoma
  2. Leydig or sertoli cell tumor
  3. yolk sac tumor
  4. choricocarcinoma, embryonal carcinoma
  5. Seminoma
82
Q

Which ovarian tumor matches each?

1) Estrogen secreting leading to precocious puberty
2) Produces AFP
3) Psammoma bodies
4) Testosterone secreting leading to virilization
5) Lined with fallopian tube like epithelium
6) Ovarian tumor + ascites + hydrothorax
7) Call-Exner bodies
8) Elevated beta-hCG
9) Resembles bladder epithelium

A

1) Granulosa theca cell tumor
2) Yolk-sac tumor
3) Serous cystadenocarcinoma
4) Sertoli-leydig cell tumor
5) Serous cystadenoma
6) Ovarian fibroma (meigs syn)
7) Granulosa cell tumors
8) Choriocarcinoma, dysgerminoma
9) Brenner tumor

83
Q

Which embryologic structure of the heart gives rise to each of the following?

1) Ascending aorta and pulmonary trunk
2) Coronary sinus
3) Superior vena cava

A

1) Truncus arteriosus
2) Left horn of sinus venosus
3) Right common cardinal vein and right anterior cardinal vein

84
Q

What is the antidote for

1) Iron
2) Lead
3) cyanide
4) Methomoglobin
5) Carbon monoxide
6) Methanol or ethylene glycol

A

1) Deferoxamine
2) EDTA , succimer, dimercaprol
3) Nitraites, hydroxycobalamin, thiosulfate
4) Methylene blue, vit C
5) 100% oxygen hyperbaric oxygen
6) Fomepizole, ethanol, hemodialysis

85
Q

Hematogenous spread of carcinomas

A

Four Carcinomas Route Hematogenously

Follicular thyroid carcinoma
Choriocarcinoma
Renal cell carcinoma
Hepatocellular carcinoma

86
Q

Clearance (CL)=`

A

Rate of elimination of drug/ plasma drug concentration

= Vd x Ke (elimination constant)

Ke= 0.7/t(1/2)

CL= (0.7 x Vd)/ t(1/2)

87
Q

Loading dose=

A

(Cp x Vd)/ F

F= bioavailability
IV F= 100%

Cp= target plasma conc at steady state

88
Q

Maintenance dose=

A

(Cp x CL x tau)/ F

tau= dosage interval (time between doses, if not administered continuously, in hours)

Maintenance dose for 1 day= 24 hrs

89
Q

Alpha 1 fxn (3)

A

Increase vascular smooth muscle contraction
Increase pupillary dilator muscle contraction (mydriasis, dilation)
Increase intestinal and bladder sphincter muscle contraction

90
Q

Alpha 2 fxn (5)

A 
Decrease sympathetic (adrenergic) outflow
Decrease insulin release
Decrease lipolysis
Increase platelet aggregation
Decrease aqueous humor production
91
Q

Beta 1 fxn (4)

A

Increase HR
Increase contractility (one heart)
Increase renin release
Increase lipolysis

92
Q

Beta 2 fxn ( 7)

A 
Vasodilation
Bronchodilation (two lungs)
Increase lipolysis
Increase insulin release
Decrease uterine tone **
Ciliary muscle relaxation
Increase aqueous humor production
93
Q

M1 fxn

M2 fxn

M3 Fxn

A

M1: mediates higher cognitive functions, stimulates enteric nervous system

M2: Decrease HR and contractility of atria

M3: Increase exocrine gland secretions, increase gut peristalsis, increase bladder contraction, bronchoconstriction, increase pupillary sphincter muscle contraction (miosis)

94
Q

Preload

  • is what
  • approximated by
  • also measures
  • decreased by
A

Pressure at end of diastole (relaxation) when ventricles are the fullest right before contraction.

Approximated by ventricular End-diastolic volume

Ventricles fill from atria, atrial pressure= preload

Decreased by venous vasodilators

95
Q

Afterload

  • approximated by
  • decreased by
A

Approximated by Mean arterial pressure
Total peripheral resistance (TPR)

Decreased by arterial vasodilators

96
Q

EDV =

A

Right atrial pressure

97
Q

S1 heart sound

S2 heart sound

A

S1= mitral and tricuspid closing

S2= aortic and pulmonary closing

98
Q

Beside maneuver

1) Inspiration
2) Hand grip
3) Valsalva, standing up
4) Squatting

A

1) Inspiration
- increases venous return to right atrium
- Increase Intensity of right heart sounds

2) Hand grip
- Increase after load
- Increase intensity of MR, AR, and VSD
- Decrease AS murmur

3) Valsalva, standing up
- Decrease preload
- Decrease intensity of most murmurs
- Increase intensity of hypertropic cardiomyopathy

4) Squatting
- Increase venous return, increase preload, increase afterload
- Increase intensity of AS, MR, VSD

99
Q

Slurred curved upstroke (delta wave) between P and R

A

Wolff parkinson white

Abnormal fast accessory conduction pathway from atria to ventricle (bundle of kent) bypassing AV node

May result in SVT

100
Q

Pulmonary capillary wedge pressure approximation of

A

left atrial pressure

101
Q

Drugs that cause pulmonary fibrosis

A

Amiodarone
Bleomycin
Busulfan

102
Q

Drugs taht cause flushing

A

Vancomycin
Niacin
Adenosine
Dihydropyridine Ca channel blockers

103
Q

Drugs that cause Torsades de pointes

A 
Potassium channel blockers 
Na channel blockers
Macrolides
Haloperidol
Chloroquine
Protease inhibitors
104
Q

Drugs that cause gingival hyperplasia

A

Phenytoin

Verapamil

105
Q

GI bleeding

Buccal pigmentation

A

Peutz jegher syndrome

Hamartomatous GI polyps, hyperpigmentation of
mouth/feet/hands/genitalia

106
Q

Tuberous Sclerosis

A

HAMARTOMASS

Hamartomas in CNS and skin
Angiofibromas
Mitral regurg
Ash lead spots
Cardiac rhabdomyoma
Tuberous sclerosis
autosomal dOminant
Mental retardation
renal Angiomyolipoma
Seizures
Shagreen patches
107
Q

78 y.o to office with one month history of progressive dyspnea, generalized weakness, fatigue and palpitations. He reports tingling and numbness in both lower limbs. Hes not been taking care of himself since wife died. CV exam shows displaced apical impulse at 6th intercostal space, a third heart sound, and high volume carotid pulses. Pedal edema, mild hepatomegaly. Normal blood counts. What deficiency?

A. Ascorbic acid
B. Cobalamin
C. Niacin
D. Pyridoxine
E. Retinol
F. Riboflavin
G. Thiamine
A

G. Thiamine

Wet beriberi

  • peripheral neuropathy
  • heart failure
108
Q

Normal cardiac pressures

1) RA
2) RV
3) Pulmonary artery
4) Pulmonary artery wedge
5) LA
6) LV
7) Aortia

A

1) RA= < 5
2) RV= 25/5
3) Pulmonary artery= 25/10
4) Pulmonary artery wedge= < 12 (10)
5) LA= < 12 (10)
6) LV= 130/10
7) Aorta= 130/90

109
Q

Cachexia

A

TNF-alpha, IFN -gamma, IL-1 IL-6

110
Q 
Unusually muscle movements of thumb
Hypoplastic mandible
Low set ears
Bifid uvula
Cleft palate
A

Physical features of DiGeorge syndrome

Hypocalcemia

111
Q

Schistocytes associated with

A

HUS, TTP, DIC and AORTIC STENOSIS

112
Q

Structure gives rise to heart structure

1) Smooth parts of left and right ventricles
2) Smooth part of right atrium
3) Trabeculated left and right atria
4) Trabeculated parts of the left and right ventricles

A

1) Smooth parts of left and right ventricles
- Bulbus cordis

2) Smooth part of right atrium
- Right horn of sinus venosus

3) Trabeculated left and right atria
- Primitive atria

4) Trabeculated parts of the left and right ventricles
- Primitive ventricle

AM- STEP1 (20 decks)

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